Successful Treatment of Severe Alopecia Areata With Oral or Topical Tofacitinib

July 2018 | Volume 17 | Issue 7 | Case Reports | 800 | Copyright © July 2018


Michelle W. Cheng BS,a Amy Kehl MD,b Scott Worswick MD,a Carolyn Goh MDa

aDavid Geffen School of Medicine UCLA, Los Angeles, CA bUCLA, Los Angeles, CA

Table1mean age 42.5 (range, 28-58 years) and mean duration of disease 5.6 years (range 3-10 years). Each was treated with 2% tofacitinib cream twice daily for a mean duration of 7 months (range, 3-11 months). One patient was observed to have excellent results with a 93.3% change in SALT score from baseline (initial SALT 100%, SALT after treatment 6.5%). In this patient, CBC, CMP, and lipids remained at baseline. Two of the four patients saw no improvement or progressive loss of hair (patient was previously treated with oral tofacitinib with robust results, but oral treatment was discontinued due to lack of insurance coverage). One patient was concurrently treated with methotrexate 25 mg weekly and prednisone 10 mg daily. Hair regrowth in this patient was reported at application site of tofacitinib cream, but no photographs or SALT scores were recorded. No adverse events were reported in any patient.

DISCUSSION

Our results suggest that oral tofacitinib may be an effective option for patients with severe alopecia areata and that higher dose treatment may be necessary in some patients with unsatisfactory results on standard dose oral tofacitinib. Compared to previous studies, we found our patients to have a shorter time to first response (1.36 mos vs 4.2 mos), though this was patient reported, and greater percent improvement in SALT score (61.18% vs 44.3%).10 Most patients noticed at least mild regrowth within the first three months, but some required more time to see significant growth. Five of our eleven patients